The document discusses anaemia in pregnancy in India. It notes that over 70% of pregnant women in India are anaemic, which has remained unchanged for decades. Maternal anaemia is a major cause of maternal mortality in India, accounting for around 20% of deaths. It also increases the risk of low birth weight, preterm birth, and infant and child mortality. National programmes to provide iron and folic acid supplements to pregnant women have had problems with implementation and compliance. New initiatives under the National Rural Health Mission aim to screen all pregnant women for anaemia and provide appropriate oral or injectable iron therapy depending on hemoglobin levels. However, challenges remain in ensuring full coverage and compliance with treatment.
Effectiveness of vitamin A supplementation for preventing morbidity and morta...Health Evidence™
Health Evidence™ hosted a 60 minute webinar examining the effectiveness of vitamin A supplementation for preventing morbidity and mortality in children from six months to five years of age. Click here for access to the audio recording for this webinar: https://youtu.be/fuWd7TJQYEI
Dr. Aamer Imdad, MBBS, MPH, Assistant Professor of Pediatrics, SUNY Upstate Medical University led the session and presented findings from their recent Cochrane review:
Imdad A, Mayo-Wilson E, Herzer K, & Bhutta Z. (2017). Vitamin A supplementation for preventing morbidity and mortality in children from six months to five years of age. Cochrane Database of Systematic Reviews, 2017(3), CD008524.
Vitamin A deficiency is a major public health problem in low- and middle-income countries, affecting 190 million children under five years of age and leading to many adverse health consequences, including death. This review examines the effectiveness of vitamin A supplementation (VAS) for preventing morbidity and mortality in children aged six months to five years. Forty-seven randomized control trials involving approximately 1,223,856 children were included in this review. VAS was associated with a clinically meaningful reduction in morbidity and mortality in children.
NATIONAL VITAMIN A DEFICIENCY PROPHYLAXIS PROGRAMMESKanikaRastogi13
this presentation is about the governmental organised national vitamin A prophylaxis programme which aims to reduce or to prevent the prevalence of vitamin A deficiency.
Effectiveness of vitamin A supplementation for preventing morbidity and morta...Health Evidence™
Health Evidence™ hosted a 60 minute webinar examining the effectiveness of vitamin A supplementation for preventing morbidity and mortality in children from six months to five years of age. Click here for access to the audio recording for this webinar: https://youtu.be/fuWd7TJQYEI
Dr. Aamer Imdad, MBBS, MPH, Assistant Professor of Pediatrics, SUNY Upstate Medical University led the session and presented findings from their recent Cochrane review:
Imdad A, Mayo-Wilson E, Herzer K, & Bhutta Z. (2017). Vitamin A supplementation for preventing morbidity and mortality in children from six months to five years of age. Cochrane Database of Systematic Reviews, 2017(3), CD008524.
Vitamin A deficiency is a major public health problem in low- and middle-income countries, affecting 190 million children under five years of age and leading to many adverse health consequences, including death. This review examines the effectiveness of vitamin A supplementation (VAS) for preventing morbidity and mortality in children aged six months to five years. Forty-seven randomized control trials involving approximately 1,223,856 children were included in this review. VAS was associated with a clinically meaningful reduction in morbidity and mortality in children.
NATIONAL VITAMIN A DEFICIENCY PROPHYLAXIS PROGRAMMESKanikaRastogi13
this presentation is about the governmental organised national vitamin A prophylaxis programme which aims to reduce or to prevent the prevalence of vitamin A deficiency.
Clinical Cases from Resource Limited Settings: Suzinne Pak-GorsteinUWGlobalHealth
Participants will be able to: recognize importance and identify resources for learning about a country and local 'disease' profile; local/regional guidelines and algorithms appropriate for the specific clinical setting; how to address limitations in clinical resources for diagnosis and management of clinical cases; and understanding health care service structure and personnel/staffing structure.
The Adolescent Girls' Anaemia Control Programme: A decade of programming expe...POSHAN
This presentation was made by Preetu Mishra (UNICEF) in the session on 'Implementation research on delivery of interventions during pre-pregnancy through lactation' at the POSHAN Conference "Delivering for Nutrition in India Learnings from Implementation Research", November 9–10, 2016.
For more information about the conference visit our website: www.poshan.ifpri.info
The Importance of Women and Children`s NutritionA-VPD
Pregnant women and children in Asia are vulnerable to multiple micronutrient deficiencies. This presentation is to educate all women the importance of Iron+Folate and other micronutrients supplementation.
Guidelines for Control of Iron deficiency Anemia, National Iron plus Initiative by Govt. of India, Causes of Iron deficiency anemia in Infants, Children, Adolescents, Non pregnant and Pregnant Women, Supplementary Nutrition for all under ICDS project
Severe Acute Malnutrition (SAM) and Nutrition Rehabilitation Centre (NRC)- Dr...Yogesh Arora
A presentation on severe acute malnutrition and nutritional rehabilitation center. Various preventive, promotive, and curative aspects of SAM are discussed in this presentation.
Clinical Cases from Resource Limited Settings: Suzinne Pak-GorsteinUWGlobalHealth
Participants will be able to: recognize importance and identify resources for learning about a country and local 'disease' profile; local/regional guidelines and algorithms appropriate for the specific clinical setting; how to address limitations in clinical resources for diagnosis and management of clinical cases; and understanding health care service structure and personnel/staffing structure.
The Adolescent Girls' Anaemia Control Programme: A decade of programming expe...POSHAN
This presentation was made by Preetu Mishra (UNICEF) in the session on 'Implementation research on delivery of interventions during pre-pregnancy through lactation' at the POSHAN Conference "Delivering for Nutrition in India Learnings from Implementation Research", November 9–10, 2016.
For more information about the conference visit our website: www.poshan.ifpri.info
The Importance of Women and Children`s NutritionA-VPD
Pregnant women and children in Asia are vulnerable to multiple micronutrient deficiencies. This presentation is to educate all women the importance of Iron+Folate and other micronutrients supplementation.
Guidelines for Control of Iron deficiency Anemia, National Iron plus Initiative by Govt. of India, Causes of Iron deficiency anemia in Infants, Children, Adolescents, Non pregnant and Pregnant Women, Supplementary Nutrition for all under ICDS project
Severe Acute Malnutrition (SAM) and Nutrition Rehabilitation Centre (NRC)- Dr...Yogesh Arora
A presentation on severe acute malnutrition and nutritional rehabilitation center. Various preventive, promotive, and curative aspects of SAM are discussed in this presentation.
Abstract—This study was aimed to find out the maternal factors and fetal outcomes associated with anemia in 3rd Trimester pregnancy. A hospital based cross sectional descriptive type of observational study was carried out in 15 to 49 years who had undergone delivery at SP Medical College Bikaner. Information about the demographic profile, ANC factors and foetal outcome data were collected. To find out associating factors appropriate test of significances were used. The magnitude of anemia 91.3% (995/1090) was found high in third trimester of pregnancy. Caste, dietary – habit, Education, Occupation, Socio-economic status, ANC Visit, Iron and folic acid supplementation were associated (P<0.05)>0.05) with anemia. Although IUGR, premature births and still births were observed respectively 2.56 times (95% CI: 0.615 to 10.697 ), 1.3 times (95% CI: 0.723 to 2.351 ) and 0.651 times (95% CI: 0.286 to 1.481 ) in anemic mothers but it was not found significant with anemia status. But significantly more (35.5%) low-birth weight babies were born to anemic mothers as compared to ( 14.7% )among non- anemic mothers i.e. 3.181 times (Odds ratio) higher LBW babies in anemic mothers. Anemia in pregnancy may be reduce by proper Iron and folic acid supplementation which can be improved through IEC and providing proper ANC services.
Anemia Free India Gynaecologist to focuss on *12gm Haemoglobin at Delivery I...Lifecare Centre
Important Highlights
Prophylactic Iron and Folic Acid Supplementation in all six target age groups.
Intensified year-round Behaviour Change Communication (BCC) Campaign for:(a) improving compliance to IFA and deworming, (b) enhancing appropriate infant and young child feeding practices, (c) encouraging increase in intake of iron-rich food through diet and/or fortified foods (d) ensuring delayed cord clamping .
Testing and treatment of anaemia, using digital methods and point of care treatment, with special focus on pregnant women and school-going adolescents.
Addressing non-nutritional causes of anaemia
in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
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This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
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Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
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Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
1. Anaemia in pregnancy–challenge or opportunity?
Prema Ramachandran
Director Nutrition Foundation of India and
President , National Academy of Medical Sciences
2. Magnitude of the problem
Why is anemia so common?
Why anaemia in pregnancy is a cause of grave
concern?
National anaemia prophylaxis/control programmes
Problems in implementation
New initiatives in the Tenth Plan – NRHM
Challenges and opportunities in Eleventh Plan
4. Prevalence of anaemia Source: WHO
Global Developed Developing India
Urban Rural
Children<5 yrs 43 12 51 60 70
Children > 5yrs 37 7 46 50 60
Men 18 3 26 35 45
Women 35 11 47 50
60
Pregnant 59 14 51 65
75
Women
About one third of the global population ( over 2 billion
persons ) are anaemic .
Anaemia is the most common nutritional deficiency
disorder in the world
Prevalence of anaemia is higher in developing countries
5. AN
0
10
20
30
40
50
60
70
80
90
Bangladesh China India Indonesia Malaysia Myanmar Nepal Pakistan Philippines Singapore Srilanka Thailand
Prevalence of anaemia is high in South Asia. Even
among South Asian countries prevalence of
anaemia in pregnancy is highest in India.
6. YEAR AUTHOR PLACE PREVALENCE %
1975 Sood et al Delhi 80
1982 Prema Hyderabad 75
1987 Agarwal et al Bihar & UP 87
1989 Christian et al Chandrapur, Panchmahal 87,88
1988-92 Agarwal et al Rural Varanasi 94
1989 ICMR 11 states 87
1994 Sheshadri Baroda 74
2000 NFHS 2 All India 52.0?
99- 2000 ICMR 11 states 84.6
2002-04 DLHS –2 All districts 90.4
2006 NNMB 8 states 70.3
2007 MFHS 3 All India 57.9?
Trends in prevalence of anaemia in pregnant women in India
Over 70 % of pregnant women in India are anaemic. There
has been no decline in anaemia in the last three decades
7. Prevalence of Anaemia (%){DLHS 2003}
0%
20%
40%
60%
80%
100%
preschool
children
adolescent girls pregnant w omen
Group
Percentage
severe moderate mild no anaemia
Anaemia begins in childhood, worsens during
adolescence in girls and gets aggravated during
pregnancy
8. Source: NNMB 2003
Among the southern states, prevalence of anaemia in
pregnancy is lower in Kerala and Tamil Nadu -?due to
better access to health care
9. Anaemia pregnant women, India
(Age between 15 - 44 years)
50.9
52.9
51.4
36
36
36
3
2
3
RURAL
URBAN
TOTAL
Mild Moderate Severe
Source : DLHS2
DLHS –2 showed that over 90% of pregnant women are
anaemic both in urban and in rural areas
10. Prevalence of anaemia in children, adolescent
girls and pregnant women from 3 surveys
0
20
40
60
80
100
NNMB ICMR DLHS NNMB ICMR DLHS NNMB DLHS
Pregnant w omen Adolescent girls Children
Normal Mild Moderate Severe
Source NNBM
Majority of children, adolescents, adult men& women are
anaemic.
Anaemia antedates pregnancy& gets aggravated during
pregnancy. Maternal anaemia results in poor iron stores in
foetus
Prevalence anaemia in children is high because of poor
iron stores, low iron content of breast milk and
complementary foods.
There is thus an intergenerational self perpetuating vicious
11. Prevalence of anaemia in adolescent girls & pregnant
women by education & standard of living index
0
20
40
60
80 Illiterate
0-9 yrs
>10yrs
Low
Medium
High
Illiterate
0-9 yrs
>10yrs
Low
Medium
High
Education Standard of living
index
Education Standard of living
index
Adolescent girls Pregnant women
Severe ModerateSource: Ref 7.11.1.6
Prevalence of anaemia is high even in high income
groups and among well educated pregnant women
13. Major causes of anemia
Inadequate iron, folate intake due to low vegetable
consumption and perhaps low B12 intake
Poor bioavailability of dietary iron from the fibre,
phytate rich Indian diets
Chronic blood loss
Increased requirement of iron during pregnancy
14. Nutrients NNMB
Rural Urban
1975-
79
1988-90 1996-97 2000-01 2004-05 1975-79 1993-94
Iron (mg) 30.2 28.4 24.9 17.5 14.8 24.9 18.96
Vit C 37 37 40 51 44 40 42
Folic
acid
* * 153 62 52.3 * *
Time trends in intake of iron, folic acid and vitamin C in rural
and urban areas (c/day) – (NNMB)
Dietary intake of iron and folate are less than 50% of the RDA
Bioavailability of iron from phytate and fibre rich Indian diets is
only 3 %
15. Time trends in intake of iron (mg / day) in different groups
Age group 1975-79 1996-97 2000-01 2004-05
10-12
B 19 20 12.2 12
G 18 19 12.1 11.5
13-15
B 21 21 15.4 13.3
G 20 21 12.9 13
16-17
B 25 26 16.7 16.4
G 22 22 15.3 13.4
Adult males 26 27 17.5 19.6
Adult females(NPNL) 21 22 17.1 13.8
Pregnant women 20 23 14 14
Lactating women 23 23 14.6 14.7
Iron intake is low in all age groups and does not increase
in pregnancy; there has been no increase in iron intake over
17. INDIA
India’s share in global maternal deaths
It is estimated that globally there are over 5 lakh maternal
deaths every year.
There are about 1 to 1.2 lakh maternal deaths in India every
year
India with 16% global population accounts for 20-25 % %
of all maternal deaths in the world
18. Prevalence of Iron deficiency anemia in South Asia%
Country Children
< 5 years
Women
15-49 years
Pregnant
women
Maternal deaths
from anemia
Afghanistan 65 61 - -
Bangladesh 55 36 74 2600
Bhutan 81 55 68 <100
India 75 51 87 22000
Nepal 65 62 63 760
South Asia
Region Total
25,560
World Total 50,000
About half the deaths from anaemia in the world
occur in South Asian countries. India accounts for
over 80% of deaths due to anaemia in South Asia
20. Consequences of anaemia in pregnancy
8-11 g/dL: easy fatigability, poor work capacity
5-7.9 g/dL: impaired immune function, increased
morbidity due to infections
<5 g/dL: compensated stage: increased
morbidity and maternal mortality due to
inability to withstand even small amount of
bleeding during pregnancy /delivery and
increased risk of infections
<5 g/dL: decompensated stage about 1/3rd
develop severe congestive cardiac failure and
many with congestive failure succumb either
during pregnancy or during labour
There is 8 to 10 fold increase in ↑ MMR when
the Hb is <5 g%
21. Effect of maternal hemoglobin level on birth weight and
perinatal mortality ( Prema 1982)
Effects on Hemoglobin (g/dL)
<5 5-7.9 8-10.9 11.0
Mean birth weigh(g) 2,400 2,530 2,660 2,710
Perinatal mortality
(rate/1000 live births)
500 174 76 55
Maternal anaemia is associated with poor intrauterine
growth and increased risk of preterm births resulting in
increase low birth weight rates.
This in turn results in higher perinatal morbidity and
mortality, higher IMR and poor growth trajectory in infancy,
childhood and adolescence. A doubling of low birthweight
rate and 2 to 3 fold increase in the perinatal mortality rates
is seen when the Hb falls <8 g%
22. Immune status of anaemic pregnant women
•There is a fall in T and B cell count when maternal
Hb is below < 11 g/dL
•The fall in T and B cell counts are significant
when Hb is <8g/dL
•There is no alterations in lymphocyte
transformation or in cell mediated immunity
• Prevalence of morbidity due to infections
including asymptomatic bacteriuria is higher in
anaemic pregnant women
•Higher morbidity rates might contribute to the
higher low birth-weight rates in anaemic pregnant
women
24. Programmes for prevention and management of
anaemia in pregnancy
India was the first developing country to take up a
National Nutritional Anaemia Prophylaxis Programme to
prevent anaemia among pregnant women and children in
1973
At that time AN care coverage under rural primary health
care was very low and there was no provision for
screening pregnant women for anaemia. Therefore an
attempt was made to identify all pregnant women and give
them100 tablets containing 60mg of iron&500μg of folic
acid
In hospital settings, screening for anaemia and iron-
folate therapy in appropriate doses and route of
administration for the prevention and management of
anaemia have been incorporated as an essential component
25. Management of anaemia in pregnancy
Obstetric text books in India provided country
specific protocols for management of anaemia,
based on studies carried out in the country
Hb < 5 g/dL
Constitute 5- 10 % of anaemic women
Admission and intensive care preferably in
secondary or tertiary care institutions to ensure
maternal and fetal salvage
Hb 5 to 7.9g/dL
Constitute 10 to 20% anaemic women
Screen for systemic/obstetric problems and
infections
If she has no other systemic or obstetric problems
26. Total Dose IV Iron (TDI) therapy
Safety and efficacy of Intravenous total dose
iron therapy was proved by trials undertaken by
Dr Menon
Subsequently IV total dose iron therapy was used
in several hospitals in Chennai and and elsewhere
Advantage : Only two day hospital admission
Disadvantage: On rare occasions anaphylactic
reaction occurred; even in the tertiary care
hospitals it was not possible to save all women
who had anaphylactic reaction
In view of this TDI was given up and
intramuscular iron therapy was preferred
27. Effect of IM iron dextran on Hb &birth weight (Prema 1982)
Group No. No.
Hb < 8g/dl untreated 443 2530 + 651
IM iron from 20 weeks 76 2890 + 428
IM iron from 28 weeks 105 2734 + 416
None of the women who received 1gm of IM iron dextran
had Hb less than 11g/dl at delivery
IM iron therapy
IRON DEXTRAN- Following initial successful trials by Dr
Menon, Dr Bhatt and others, IM iron dextran injections were
widely used in hospital settings often on out patient basis ;
about 1/3rd
develop fever arthralgia or myalgia
IRON SORBITOL COMPLEX : Initial trials by Dr Menon
showed promising results but it was not so widely used
because 1/3rd
of the drug gets excreted in urine and higher
dose of elemental iron is required .Side effects are mild :
29. Content of antenatal care
(Household survey, 1998-99)
0
20
40
60
80
100
Bihar UP Haryana TN
Any ANC Weight taken
BP check up Abdominal check up
IFA
DLHS 1 (1998-99) showed that pregnant women were not
being screened for anaemia and given appropriate therapy
All pregnant women who were given antenatal check up
were given tablets containing iron (100mg) and folic acid 500
μg.
Most women in poorly performing states did not come for
antenatal check up. Many of those who came, did not get
30. %of pregnant women who received some IFA
tablets (NNMB)
0
20
40
60
80
100
Kerala Tamil Karnataka Andhra Mahara- Madhya Orissa
Proportion of pregnant women who receive IFA tablets is not
high even among well performing states like Tamil Nadu , Kerala
and Maharashtra .
Many of those who received IFA did not receive 100 tablets
Many of those who received did not take the tablets regularly
31. Hb in Pregnant women taking Iron Supplementation(ICMR 2000)
No of tablets ingested
No.
Hb (g/dL)
Mean S.D
1-15 310 8.8 1.7
16-30 251 9.2 1.5
31-60 196 9.3 1.8
61-90 99 9.2 1.6
>90 74 9.1 2.1
Total who had IFA 930 9.1 2.2
B.Not known 16 9.1 2.6
C.Not had IFA 3829 9.1 3.8
A+B+C 4775 9.1 3.5
ICMR study confirmed that most women received 90 tablets
without Hb screening. Many did not take tablets regularly.
Even among small number of women who took over 90
32. IM iron therapy
IM iron therapy mainly iron dextan was used mainly
in some medical colleges and rarely at district
hospitals. It never reached primary health care level
There were problems in ensuring continuous supply
of drugs even at medical colleges
Some women found it difficult to come to OPD daily
for ten days for IM injections
Though women who were counseled agreed to IM
therapy, those who developed trouble some side
effects like arthralgia wanted to discontinue;
convincing them to continue was difficult
34. New Initiatives in the Tenth Plan
Emphasis on screening all pregnant women for
anaemia and providing appropriate treatment depending
upon Hb levels
Anaemia prophylaxis For women who are not anaemic
one tablet of iron 100mg and 500 μg folic acid once a
day would be sufficient to prevent any deterioration in
Hb levels
Oral iron therapy for mild anaemia Majority of anaemic
women in pregnancy have mild anaemia . Oral iron
folate therapy (one tablet of iron 100mg and 500 μg
twice a day) regularly should be able to improve their
Hb
IM iron therapy for moderate anaemia One fifth of
pregnant women have moderate anaemia. They should
get IM iron therapy
35. Components of antenatal care DLHS -2
16.4
20.4
27.6
42.2
41.4
43.8
42.1
49.8
17.4
Sonogram/Ultrasound
Height measured
Internal examination
Urine tests
Weight measured
Blood tests
Blood pressure checked
Abdominal examination
Breast examination
DLHS 2 (2006) showed that there was some
improvement in coverage and content of antenatal
care. About 40% women had blood examination –
which might include Hb estimation .
36. Iron & Folic Acid Supplementation
in pregnancy DLHS – 2
Iron & Folic Acid Supplementation
in pregnancy DLHS – 2
No IFA
38%
Received but
not consumed
5%
One IFA
39%
Two or More
18%
35.3
20
Less than 100
IFA
100+ IFA
IFA Per Day
During Entire Pregnancy
DLHS 2 also showed that there has been some improvement
in % of pregnant receiving IFA tablets.There has been a
significant reduction in the % of women who received but did
not consume the tablets. These data suggest that if all pregnant
women are screened for anaemia and provided appropriate
therapy it might be possible to achieve substantial reduction in
37. Impact of IM iron sorbital on Maternal Hb & birth-
weight(NFI)
Maternal Hb (g/dl) N Birth weight(g)
I - < 8.0 97 2577+378.3
II - 8.0 – 11.0 645 2796+394.7
III - > 11.0 103 2921+418.1
Total 845 2786+4055
All women who had IM iron
therapy
340 2805+379.3
NFI study showed that IM iron sorbital therapy is feasible in
primary care institutions. Mean Hb rose and there was
significant improvement in birth weight. BUT majority of
women who received 900 mg of iron sorbital had Hb levels
around 10 g/dl and birth weight was lower than the birth
weight in non-anaemic women.
It would appear that 1500mg of iron sorbital citric acid
complex would be required for optimal results .
38. Side effects of IM iron sorbitol citric acid complex
Metallic taste in the mouth 32.4%
Nausea/vomiting 15.3%
Pain at the site of injection 38.3%
Infection at the injection site 0.3%
None had muscle or joint pain which is commonly
seen with iron dextran injections
Nausea and vomiting was treated with anti-emetics.
Patients with pain at injection site were given
paracetamol and IM iron therapy continued; one patient
who developed infection responded to antibiotics
40. Challenges in anaemia prevention and control
programmes
Majority of Indians are anaemic
Over 3/4th
of pregnant women are anaemic
There has not been any decline in the prevalence of
anaemia or its adverse consequences on mother
child dyad over the last six decades
42. Strategy for prevention of anaemia in pregnancy
health and nutrition education to improve over all
dietary intakes and promote consumption of iron
and folate-rich foodstuffs- possible through NRHM’s
health and nutrition days
dietary diversification inclusion of iron folate rich
foods as well as food items that promote iron
absorption- possible with proper linkages with
National Horticultural Mission
introduction of iron and iodine-fortified salt
universally to improve iron intake- possible with
NIN technology
Opportunity: Affordable & sustainable interventions
to improve iron and folate intake of the entire
family and prevent anaemia are readily available .
43. Strategy for prevention of anaemia in pregnancy
focus on Hb estimation for detection and treatment of
anemia in adolescent school girls as a part of school health
check – possible through school health system
focus on Hb estimation in girls / women who are married,
for detection and treatment of anemia prior to pregnancy-
can be attempted through coordination with AWW
screening all pregnant women for anemia-Possible using
filter paper technique
providing one tablet of IFA to prevent any fall in Hb levels
in non anaemic pregnant women- possible through NRHM
Opportunity:All these interventions are feasible& affordable
for the individual and health system. With universal coverage
and monitored supplementation it is possible to ensure that
non anaemic women do not become anaemic
44. Strategy for detection&management of anaemia in pregnancy
iron folate oral medication at the maximum tolerable dose
throughout pregnancy for women with Hb between 8 –10.9g/dL –
possible through convergence between AWW and ANM
IM iron therapy for women with Hb between 5 and 7.9 g/dL if
they do not have any obstetric or systemic complication- possible
with urban & rural PHCs taking the major responsibility
hospital admission and intensive personalised care for women
with haemoglobin less than 5 g/dl- possible with referral to tertiary
care centres using of emergency transport funds and ASHA
screening and effective management of obstetric and systemic
problems in anaemic pregnant women possible in hospitals
improvement in health education to the community to promote
utilisation of available care possible through AWW, ASHA, ANM
and PRI
Opportunity:All these interventions are feasible& affordable
for the individual and health system.
45. Opportunities for prevention, detection and
appropriate management of anemia in pregnant
women
India currently has the necessary infrastrucutre ,
manpower, technology for this task
Indians are rational and responsive; people’s
institutions are in place providing the necessary
community support
Prevention, detection and appropriate management
of anemia in pregnant women and preventing the
adverse consequences of anaemia on the mother
child dyad is feasible under NRHM and its urban
counterpart